Provider Demographics
NPI:1265677355
Name:GUPTA, SWATI (PT)
Entity type:Individual
Prefix:
First Name:SWATI
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 SAN GABRIEL
Mailing Address - Street 2:APT 7101
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7290
Mailing Address - Country:US
Mailing Address - Phone:786-261-6730
Mailing Address - Fax:
Practice Address - Street 1:4206 SAN GABRIEL
Practice Address - Street 2:APT 7101
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7290
Practice Address - Country:US
Practice Address - Phone:786-261-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist